(WOMENSENEWS)
--A recent survey of Colorado
physicians about a state law
requiring them to report domestic
violence injuries shows a
low level of compliance by
doctors.

The surprising
results are raising profound
questions about the effectiveness
of mandatory domestic violence
reporting laws.

The participating
physicians' responses, said
Kim Feldhaus, a Denver emergency
physician and professor who
conducted the survey published
in January, suggest that while
requiring physicians to report
incidents of domestic violence
to legal authorities may help
some victims, it doesn't safeguard
women adequately.

Routine screenings
by doctors' offices for domestic
violence, other experts argue,
could be a better alternative
that empowers patients to
take charge of their own lives
by offering them information
and support.

Of the 684 Colorado
physicians surveyed by Feldhaus,
only 4 in 10 reported domestic
violence injuries to the police.
Emergency physicians were
found more likely than family
physicians to report the injuries
to police.

The doctors
surveyed indicated that many
patients didn't want their
injuries reported to police
for fear of retaliation by
their attackers. Some doctors
said they feared for the patient's
safety even when police were
called. Police may interview
the perpetrator against the
patient's wishes, doctors
told Feldhaus, or arrest and
release the batterer, increasing
the danger of retaliatory
violence.

"Denver
tries to do these cases within
72 hours," said Feldhaus,
"but surely these perpetrators
are not all going to jail.
Some are being charged, but
released, or on parole. So
there's always retaliation
involved and we know that
it always gets worse when
the victim is trying to separate."

Feldhaus said
emergency physicians are more
likely to report domestic
violence to police because
the injuries they see are
more severe and they are less
likely to know the victim
and her intimate partner.
Family physicians usually
see less critical injuries
and may know and treat the
perpetrator and children as
well as the victim, increasing
their concern about retaliation.

Pitfalls
of Mandatory Reporting

The survey,
Feldhaus said, reveals how
difficult it is for physicians
to comply with so-called mandatory
reporting laws--also on the
books in California, Kentucky
and Texas--while taking care
of their patients' safety.
"It's a huge dilemma,"
she said.

Doctors face
the problem of honoring patient
confidentiality and choice
when the injured woman doesn't
want the abuse reported to
police. "Physicians in
states with mandatory reporting
laws come across circumstances
where they are clearly in
conflict with their patients'
rights," said Feldhaus.

Doctors say
that even when they report
domestic violence cases, police
don't always charge the perpetrator,
or else they may jail him
only briefly, depending on
the features of the criminal
legal process. Sometimes making
a police report, doctors say,
results in batterers retaliating
with more violence against
the patient. On the other
hand, doctors know that not
reporting doesn't safeguard
patients either.

Doctors told
Feldhaus they sometimes feel
helpless to stop the violence.
"Even when patients talk
to police and to social services,
they make their own decisions
and sometimes those decisions
are to return to the assailant.
It may seem like a bad choice
to a physician but it's the
patient's right to make that
choice," said Feldhaus.
Physicians can warn a spouse
of their concerns, tell her
that the abuse is a crime,
but cannot force her to go
somewhere different than she
wants to go, Feldhaus added.

"Our legal
system cannot keep these victims
safe. We see it every day,"
said Feldhaus, the leader
of several domestic violence
studies. "It's the ex-boyfriend
that shoots you, the ex-husband
that tracks you down."
Domestic violence specialists
say abusers fear loss of control
over the victim and react
angrily to anything that threatens
such control. Abusers are
often concerned about having
the woman out of his immediate
control and can try to restrict
her activities, including
shopping or visiting family
and friends. A woman's statement
to an abuser that she is separating
from him or her act of reporting
the abuse to police may precipitate
additional violence.

Karen, a California
woman, tells such a story
on the Web site of the Family
Violence Prevention Fund,
a national organization based
in San Francisco, Calif.:

"During
the last two years of our
marriage I tried to leave
many, many times. Each time
I attempted to leave he would
accelerate his violence. Once
I got as far as getting into
my car, but he opened the
car door before I could lock
it. He bashed my head against
the inside of the passenger
door and dragged me screaming
all the way down the block
to our apartment."

Domestic
Violence Has Epidemic Proportions

Nearly a third
of U.S. women report being
physically or sexually abused
by a husband or boyfriend
at least once over a lifetime,
according to a survey by The
Commonwealth Fund in New York,
quoted on the Web site of
the Family Violence Prevention
Fund.

The federal
Centers for Disease Control
and Prevention in Atlanta
offered a lower, but still
very high statistic. In a
press release in February,
federal agency said, "Twenty-five
percent of women report physical
or sexual assault by a current
or former partner during their
lifetime." The health
impact of these assaults extends
beyond the violence injuries,
the agency said, including
higher rates of unintended
pregnancy, increased risk
for sexually transmitted diseases,
multiple mental health problems
including depression and panic
attacks, various gynecological
problems, stomach ulcers,
migraine headaches, spastic
colon and other digestive
diseases.

Feldhaus has
become an advocate for police,
prosecutors, social services
professionals and doctors
to work out a safer system
for domestic violence victims.

Routine Screening
Advocated for Domestic Violence

Advocates say
healthcare providers have
an alternative that's safer
and more helpful than mandatory
reporting: routine screening
for domestic violence, with
offers of support and community
resources. While performing
a routine screening, a physician
would ask about symptoms during
an examination and would question
the patient about violence
and fear of violence from
an intimate partner and offer
options for action.

"There's
a whole clinical strategy
that we believe in beyond
mandatory reporting, that
we believe is much more important,
and that is healthcare-provider
screening for women, even
intervening," said Debbie
Lee, managing director of
health at the Family Violence
Prevention Fund, which is
supported by private foundations
and the U.S. Department of
Health and Human Services.

"Because
violence is so common in many
people's lives, I've begun
to ask all my patients about
abuse. Has your partner ever
hit you or physically hurt
you, threatened you or forced
you to have sex when you didn't
want to?" said Lee, who
heads the fund's National
Health Resource Center on
Domestic Violence. "What
the healthcare provider's
role should be," she
said, "is to identify
the abuse, to provide information
about domestic violence and
the impact on her health and
to provide her with resources
in the community for help."

"A doctor
may say, 'I don't care how
angry he is, he shouldn't
hit you. You need to think
about what safety precautions
you can take--can you leave
the house? Have a suitcase
packed? Have friends to stay
with?'"

"I remember
visiting a shelter and one
woman said, 'I remember you,
I went to San Francisco General
and you asked me (about domestic
violence) and I never said
anything, but it was the start
of my understanding my situation,'"
recalled Lee. "It's like
planting a seed for someone,
that I could do something
and try to get out of it."

Move against
Mandatory Reporting

Lisa James,
program manager for the Family
Violence Prevention Fund,
added that "by asking
about abuse, they end her
isolation and provide her
with information about the
impact on her health, but
also the support that's available
to her." The resources
offered can be the police,
but referrals to law enforcement
are a small part of the picture.

"Victims
of abuse tell us regularly
that the asking of the question
was the most important intervention
for them. Not so much the
contacting police, or knowing
the resources available, but
just having the physician
ask that question," said
James.

"Imagine
you're going to the doctor
and no one ever says a word.
In a way, by not asking, the
provider and all of us are
colluding," said James.
"By asking, it acknowledges
that she is going through
this and opens up a number
of doors; it says that she
doesn't deserve it and there's
help available."

"We don't
support mandatory-reporting
laws. We support reporting
to police with the patient's
consent," added James.

Rita Smith,
executive director of the
National Coalition against
Domestic Violence, also opposes
mandatory reporting laws.

The law requires
doctors to report information
that could endanger women's
lives. The patient needs to
have control over who gets
that information, said Smith.
"Their lives are at stake."

Suzanne Batchelor
has written also for the national
science series "Earth
and Sky" and on health
and medicine for Medscape,
CBS Healthwatch, WebMD and
the Texas Medical Association's
"Healthline Texas."